Enrollment in a pre-existing condition health plan increased 50% in 3 months

[eridani]

What they don't mention is that 12,000 is an extremely tiny percentage of the 6 million who are eligible. That's because it's crappy overpriced underinsurance, of use mainly to sick affluent people.

http://www.modernhealthcare.com/article/20110210/NEWS/302109946/1010&rssfeed=rss01

National enrollment in a pre-existing condition health plan created by last year's healthcare reform law has increased by 50% in the past three months to more than 12,000 Americans, HHS said Thursday.

[BzaDem]

1. Actually, the rates in the high risk pools created by HCR are much lower than the rates in

comparable state pools that existed before HCR.

Copays and deductibles are also much lower. It is not crappy overpriced underinsurance.

The real reason enrollment is lower is because the HHS isn't spending huge amounts of money to advertise the pools. Why is this? Because they have to conserve funds, considering Republicans aren't going to appropriate any more money for this than has already been appropriated in HCR itself.

[eridani]

4. Cheaper crappy insurance is still crappy insurance n/t

[BzaDem]

5. You would define all insurance as crappy, so I'm not sure you would be satisfied under any high risk

pool proposal. The high risk pool insurance under HCR has lower deductibles/cost-sharing than many plans that AREN'T high risk pool plans.

[eridani]

8. The very notion of high risk pool insurance is evli, disgusting and immoral

It is perpetrated by mass murdering insurance companies who do not want to do the sensible thing and put everyone in the same risk pool. Selecting out sick people to fuck over financially is sociopathic, period.

[BzaDem]

12. And? What does that have to do with the question of whether the insurance offered by such pools is

shitty insurance?

I agree with you that pricing on risk should be made illegal, and it will be in 2014. But that has NOTHING to do with the shittyness or lack of shittyness of a policy offered by a current high risk pool. A high risk pool (in theory) could offer anywhere from a gold plated insurance to shitty insurance, even if you think they shouldn't exist as a concept.

[enlightenment]

19. Please provide citation for your statement.

Otherwise it's just you typing stuff. Anyone can type stuff - that doesn't make what they type true.

Please provide citation to prove your assertion that rates are lower, copays and deductibles are much lower, and the resulting product is not crappy overpriced underinsurance.

[BzaDem]

20. Sure.

http://www.hhs.gov/ociio/initiative/hi_risk_pool_facts.html

Premiums "equal a standard rate for a standard population (that is, not exceed 100 percent of the standard non-group rate)." That means about equal to the rate someone without pre-existing conditions would get. Premiums for high risk pools in states before the law generally cost MUCH more than normal, non-preexisting-condition plans for a given actuarial value.

[enlightenment]

21. As usual, the devil is in the details.

http://edocket.access.gpo.gov/2010/pdf/2010-18691.pdf

This interim final rule does not mandate a specific formula for calculating the standard rate. Instead, we specify that a PCIP may calculate the standard rate using reasonable actuarial techniques, as approved by the Secretary, that reflect anticipated experience and expenses. This requirement should accommodate reasonable variations in the methods that PCIPs may use to calculate a standard risk rate. We also recognize that individual market rates in each State can vary as a consequence of individual State insurance laws. For example, some States require that insurers issue all applicants a policy or offer coverage at a community rate. In such situations, the standard individual rate may be considerably higher than in a State that permits insurers to reject applicants or set premiums on the basis of health status or other factors. To account for these variations, § 152.21(a) of these rules provides that, subject to approval by HHS, a PCIP may use other methods of determining the standard rate in the State. The exact methodology must be submitted and approved through the proposal process as specified in § 152.8 of this part.

So, what the brief 'fact sheet' and what the actual regulations say are not exactly the same thing. They seem to have built in a little fudge room (surprise!). Whether or not this insurance is 'overpriced' would seem to be a little more iffish than you suggest, based on the regulation wording.

Then, to the point of whether or not the insurance is 'crappy underinsurance' - I don't know about you, BZA, but I don't consider 65% coverage anything to write home about - particularly when the premium is at least equivalent to (and may be more, since the states can 'vary' the formula) insurance that may cover 80%.

Limits on Enrollee Costs
Section 1101(c)(2)(B) of the Act sets limits on enrollee costs in the PCIP program. Specifically, the issuer’s share of the total allowed costs of benefits provided under such coverage cannot be less than 65 percent of such costs, subject to actuarial review and approval by the Secretary. Section 152.21(b)(1) of this rule provides that coverage under a plan offered by a PCIP must at a minimum meet this 65 percent threshold.

I suppose it is better than nothing - and that seems to be your bottom line. That for those who can afford to buy insurance that may only cover them at 65% of cost, it's better than nothing.

[BzaDem]

22. If the policy in a given pool had a 65% actuarial value, wouldn't the premium have to be equivalent

to the market rate (without pre-existing conditions) for a 65% policy? I don't think the law can be interpreted to allow the rate for a 65% policy to be set according to the standard rate for an 80% policy. An interpretation like that would allow the rate for a 65% policy to be set according to the standard rate of a 100% policy. I could be wrong though -- is there something that allows this?

[StarsInHerHair]

2. and how many who have survived breast cancer fall thru these designed

cracks in the system?

[pnwmom]

3. You obviously have no idea how the prices compare to what was previously

available -- in the cases where any insurance was available at all. (Many people have been denied completely and have no recourse to state plans.) The new plans are a vast improvement.

[eridani]

6. Shitty overpriced insurance minus X = slightly cheaper shitty insurance n/t

[BzaDem]

7. I think the problem is your perception that the plans are "shitty." If you correct for your false

assumption, it makes much more sense.

[eridani]

9. HIgh risk pool = shitty by definition

only a sociopath thinks that such things should even exist.

[BzaDem]

10. False. Whether they exist or not is a COMPLETELY separate question than whether the insurance

offered by such a pool is shitty insurance.

I don't think they should exist, since I don't think insurers should be able to discriminate on the basis of pre-existing conditions at all. Fortunately, that is exactly what will happen in 2014.

In the mean time, the high risk pools offer NON-shitty insurance at rates far below what they used to be.

[eridani]

11. They offer rates somewhat below what states offer, and are still unaffordable

--for most actual sick people.

[BzaDem]

13. The rates are set to be what someone without a pre-existing condition would pay in the individual

market for health insurance.

[eridani]

14. Yes, and individaul insruance rates offered to them are created--

--by amoral sociopaths.

[BzaDem]

15. Not sure what that has to do with the discussion.

The purpose of the high risk pool was to allow people with pre-existing conditions to get insurance at the rate they would be able to if they had no pre-existing condition. That is what the risk pool does.

[eridani]

16. It is a useless thing to do, as most can't afford those rates. n/t

[BzaDem]

18. Actually, many can afford the rates. If what you were saying is true, there would be no individual

market. But there is an individual market, and people use it.

[Mimosa]

32. You sound like you work for an insurance company.

I wish you knew what it means to have an income which varies between 38-65K a year for 2 and be paying up to $15,000 in total for health insurance and medical costs not covered by insurance.

It means those people cannot save for their old age, for one thing.

You must not know a lot of self employed people who have average varying incomes. There are way more of us in this shitty economy. BZA, you sound a bit heartless, I'm sad to say.

[BzaDem]

34. How is it a bit heartless to say that many people can afford the rates?

How does that make me sound like I work for an insurance company? How is it heartless to point out that the high risk pools are in fact helping people? I think it's more heartless to say they aren't helping people and we should therefore scrap them.

I'm not saying that it is a GOOD thing that others can't afford the rates, that nothing should be done about it, etc. On the contrary, in 2014, a HUGE amount will be done for people that can't afford the rates. No family making below 88k/year will pay more than 9.5% of their income for premiums (and that percentage gets lower and lower the lower one's income is, all the way down to 0% for families making 133% of the poverty line). This will be for plans with a large mandated benefits package and mandated actuarial value. The entire POINT of the bill is to help people who don't have insurance through their employers, for example "self employed people who have average varying incomes."

The high risk pools are only a temporary solution to a specific problem that lasts until 2014, when the real reform begins.

[eridani]

41. 12,000 out of 6 million is "many"? n/t

[BzaDem]

45. That's how many people signed up -- not how many people could afford them. n/t

[eridani]

49. You know what people can afford how, exactly? n/t

[pnwmom]

23. So everyone who disagrees with you is a sociopath?

Given the situation -- that people with preexisting conditions were prevented from getting any insurance at all -- a high risk pool was better than nothing. But the plans under Obama are much better than the state high risk pools.

[Mimosa]

29. What plans 'under Obama"

Is there something other than this at the link below? I can't afford 748 a month after paying a $2,500 deductible. And it says one has to pay 20% of all other costs too.

http://www.healthcare.gov/law/provisions/preexisting/states/ga.html

I found this link off the White house Health.gov site.

[pnwmom]

40. Do you think you could pay $4000 a month?

I'm sorry that $748 is unaffordable for you, but it is far less than what has been available to many with preexisting conditions, if they could get any insurance at all. And when the full plan goes into effect in 2014, they won't be able to charge you any more than they charge anyone in your age group, regardless of your health.

[pnwmom]

48. The standard plan premium is about $550 in the highest age group and has a lower deductible.

Why did you choose the extended plan?

[eridani]

42. Putting people in different categories because of their wealth and/or health--

--is sociopathic, period.

[NYC_SKP]

17. Just helped a dear friend get this program. Will save her hand.

Cheaper than my COBRA was, and without the program she'd be SOL.
And lose the use of her hand.

K&R

[Honeycombe8]

24. So what are the rates? There's nothing but a "join now!" thing on that web link page. nt

[BzaDem]

25. It differs by state. The rates are roughly equivalent to what a policy would cost on the individual

market in your state, if you did not have a pre-existing condition.

[Mimosa]

27. Not true, BZA. WHY are you defending the indefensible?

I've had to compare.

My $10,000 deductible Blue Cross Blue Shield individual plan, 70/30 in network, costs significantly less (more than $200 less) poor month.

And every month it's so hard to make the premiums we have that we agonise over dropping insurance. We cannot afford to save for anything because our health insurance is costing us so much. But since we are over 55 we are afraid if a catastrophic illness struck a hospital could sue us and take our house away.

BZA, I have no idea how old you are, but try to understand this from the perspective of people over 55 who are self-employed. There are many people like us because there is age discrimination and companies prefer to hire the younger people who are cheaper for insurance pools. having national health care like expanded Medicare would have separated health insurance responsibility from employers. Then they would not have that factor as one which helps cause discrimination.

The USA has an aging population, like it or not.

[BzaDem]

28. A 10k deductible plan would cost less than the type of plan sold in the HCR's high risk pools,

which are supposed to have lower deductibles.

When I say equivalent, I mean equivalent to an individual plan with the same actuarial value (i.e. same premium/deductible/cost-sharing balance).

[Mimosa]

26. Plans ARE crappy and overpriced for people over 50

Here are the rates for residents of my state, GA. The plan is administered by 'Anthem' (Blue Cross/Blue Shield). The monthly rates are prohibitive for most people. My self-employed partner and I are over 55 and not poor enough for Medicaid but we cannot afford these premiums.


Pre-Existing Condition Insurance Plan: Georgia


Eligible residents of Georgia can apply for coverage through the Pre-Existing Condition Insurance Plan program run by the U.S. Department of Health and Human Services.

To qualify for coverage:

* You must be a citizen or national of the United States or lawfully present in the United States.
* You must have been uninsured for at least the last six months before you apply.
* You must have a pre-existing condition or have been denied coverage because of your health condition.

PCIP covers a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available for you, even if it’s to treat a preexisting condition.

Below are the monthly PCIP premium rates for Georgia by the age of an enrollee.
Age Standard Option Extended Option HSA Option
0 to 18 $174 $234 $181

19 to 34 $261 $351 $271

35 to 44 $313 $422 $325

45 to 54 $400 $539 $416

55+ $557 $749 $578

In addition to your monthly premium, you will pay other costs. In 2011, you will pay a $1,000 to $3,000 deductible, which varies by your plan option, for covered medical benefits (except for preventive services) before the plan starts to pay. A plan option may have a separate drug deductible. After you pay the deductible, you will pay a $25 copayment for doctor visits, $4 to $40 for most prescription drugs, and 20% of the costs of any other covered benefits you get. Your out-of-pocket costs cannot be more than $5,950 per year. These costs may be higher, if you go outside the plan’s network.

------------------------------------------------

What the heck does "After you pay the deductible, you will pay a $25 copayment for doctor visits, $4 to $40 for most prescription drugs, and 20% of the costs of any other covered benefits you get." mean? Say if you have a chemo treatment for $700, you have to pay $200 in addition to your premium and after the deductible?

Does anybody here work for a health insurance company? That needs interpretation.

Affording that kind of coverage would be nearly impossible for anybody making under $60,000 annually.

[BzaDem]

30. Most health plans are similar.

There is a deductible that you have to pay before you get any benefits. Then, there are co-pays/cost-sharing for a certain percentage of care beyond that, up to an out of pocket maximum. 20% is a pretty common figure, though some more generous employer plans have 10% or less. 20% is certainly not out of the ordinary though.

The point of the high risk pools was to help people with pre-existing conditions get similar rates as people without them, on the individual market. For people that couldn't afford those rates to begin with, it was not going to help. But in 2014, with the exchanges and subsidies, there is quite a bit of help for people who couldn't afford those rates to begin with.

[Mimosa]

33. What help in 2014? Tax credits?

And no controls on costs of premiums, except for supposedly 80% must be spent on patients.

It is the American public who are enslaved to the health insurance industry. They are cleaning up at our expense. No other country has the patchwork mess which ACA of 2010 cemented to our people and our economy.

[BzaDem]

36. Yes. See post #34. n/t

[eridani]

44. Tax credits are useless to all but the affluent

That's because you pay up front a sum that you can hardly afford first, and that gets you tax credits only if you pay enough tax to make that useful.

[BzaDem]

46. Do you realize what you just said is completely false? The subsidies are advanced each month.

No one ever has to pay more than they will end up paying after the subsidies. No "huge sum" required.

[eridani]

50. Please explain the difference between "tax credits" and "subsidies"

Tax credits get used only when you file your taxes. Any subsidies do not go to you, but to insurance companies.

[eridani]

43. The mass murder of 44K people a year by insurance companies is common too

It still isn't OK.

[Honeycombe8]

31. I don't think those rates are outrageous at all. Here in TX....

if I were to lose my job but be able to continue my ins. through COBRA, my individual rate would be over $500 per month (I am 57, deductible about $750, co-pay $25 main dr. or $50 for gyno or other specialist, 80/20, with an out of pocket cap per year of $10,000).

My employer pays about $400 per month for me, through the group policy of over 1,000 people. So that's a cheapie rate.

Maybe my COBRA is so high because it's an entitlement, to get it, so it doesn't take into account whether there's a pre-existing condition or not. I haven't checked the rates on the open market, to see if I could do better, since I don't have a pre-existing condition. But of course, sooner or later we ALL have a pre-existing condition, don't we?

If you can get a "high risk" policy for less than $600 a month, that's pretty good. Because, after all, it's pretty much a sure bet that the co. will have to pay a claim on that policy. That's why it's a high risk policy. But at least you can get one.

When my mom got a heart condition, the ins. co. dropped her. She couldn't find coverage for awhile. Finally, she did...but it excluded her heart condition. Because of the new health care laws, that will no longer be the case, thank goodness.

[Mimosa]

35. The ACA lets the insurance companies exclude people with preexisting until 2014

People will become ill. People will die. Why did they let the exclusions continue until 2014? Could it be to give the Republicans the chance to repeal the ACA of 2010?

[BzaDem]

37. "Why did they let the exclusions continue until 2014?"

Because if the community rating/exchanges/subsidies began earlier, the 10-year cost of the plan would go above a trillion, which means Ben Nelson (and a bunch of house members) wouldn't have voted for it, which means no plan would have been enacted, which means there wouldn't have been any help for anyone even AFTER 2014.

[Mimosa]

39. BZA, to my understanding here's what happened...

US citizens were denied real change in 2010. Our Congress and our President made a big choice that 16% of the GDP was based on profit based health industry. Those corporations support a lot of politicians and have for DECADES. And rich people get richer by investing in for profit health insurance corps, pharmaceuticals, hospitals, clinics, et cetera.

Once again the message was sent to all that the wealthiest people will be protected at the expense of the working class.

[Honeycombe8]

38. Thank goodness that will be gone in 2014. nt

[mmonk]

47. You need to think of the poor insurance companies.

Taking on those sick people exposes them to more risk. They need to turn a profit. What do you think this is, Canada?